Netherton Practice

We carried out an announced comprehensive inspection at Netherton Practice on 24 February 2020 as part of our inspection programme.

At this inspection we followed up on breaches of regulations identified at a previous inspection on 11 December 2018.

This inspection looked at the following key questions:

Safe

Effective

Caring

Responsive

Well-led

At the last inspection in December 2018 we rated the practice as requires improvement for providing safe and well-led services because:

• The systems in place for safeguarding patients were not fully effective.
• Governance systems were not fully effective in monitoring the service, managing risks and driving improvement.

At this inspection we found that the provider had satisfactorily addressed the above areas.

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and good for all population groups.

We found that:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.
• Patients received effective care and treatment that met their needs.
• Staff dealt with patients with kindness and respect and involved them in decisions about their care.
• The practice organised and delivered services to meet patients’ needs. Patients could access care and treatment in a timely way.
• The way the practice was led and managed promoted the delivery of good quality, person-centre care.

Whilst we found no breaches of regulation, the provider should:

• Review safeguarding arrangements to include setting up an alert for relevant others for children at risk.
• Introduce a programme of clinical audit as part of the clinical governance in an aim to improve outcomes for patients.
• Provide reception staff with sepsis awareness training to support them in dealing with patients presenting with potential sepsis.
• Review Patient Group Directions (PGDs) to ensure designated people have been authorised to administer the vaccines.
• Monitor unplanned hospital admissions and readmissions.
• Continue to monitor and encourage cancer screening uptake for all eligible patients.
• Look to increase the number of identified carers to ensure these patients are provided with appropriate support.
• Continue to encourage uptake of patients to form a Patient Participation Group.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care.

This practice is rated as requires improvement overall.

The key questions are rated as:

Are services safe? – Requires improvement

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? – Requires improvement

We carried out an announced comprehensive inspection at Netherton Practice on 11 December 2018 as part of our inspection programme.

At this inspection we found:

• The practice had systems to manage risk and to ensure that safety incidents were less likely to happen. However, the learning from incidents was not well communicated across the staff team.
• The systems in place for safeguarding patients from the risk of abuse were not robust. This was because there was no designated lead for safeguarding in the practice and a safeguarding register had only recently been produced.
• All clinical sessions were delivered by locum GPs and an agency practice nurse. The provider had taken steps to ensure as much consistency as possible in the use of temporary staff and systems were in place to support the clinical team such as regular meetings. However, members of the clinical team were not always taking these up.
• There were systems in place to reduce risks to patient safety. A risk register was in place and this was monitored.
• There were shortages in the staff team and the practice had been taking on a high number of new patients. This was not being managed effectively and if not addressed could lead to the practice being unable to meet patients care and treatment needs in a timely and safe manner.
• Medicines were not always being managed in line with policies and procedures.
• Procedures to prevent the spread of infection were in place and regular Infection control and cleanliness audits were carried out.
• Systems were in place to deal with medical emergencies and staff were trained in basic life support.
• Clinicians assessed patients’ needs and delivered care in line with current evidence based guidance in those areas we explored.
• Data showed that outcomes for patients at this practice were comparable to outcomes for patients locally and nationally.
• Systems to review the effectiveness and appropriateness of the care provided were in place and some of these were being developed further. However, there were no clinical audits being carried out at the practice.
• Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Staff told us they felt supported in their roles.
• Patients told us they were treated with dignity and respect and involved in decisions about their care and treatment. Some patients felt there was little consistency in the clinical team. The provider had taken action to reduce the number of clinical staff used.
• Systems were in place to check on the quality of the service. However, these were not fully effective for this location as we identified shortfalls.

The areas where the provider must make improvements are:

• Ensure the systems in place for safeguarding patients include a designated safeguarding lead and ensure that safeguarding registers are reviewed on a regular basis.
• Review the governance systems to ensure these are fully effective in monitoring the service, managing risks and driving improvement.

The areas where the provider should make improvements are:

• Review staffing levels and staff capacity to ensure this is sufficient to meet demand.
• Ensure procedures relating to the management of medicines and prescribing are followed appropriately.
• Ensure that clinical audits are carried out as part of their assessment of clinical effectiveness and to improve outcomes for patients.
• Identify carers in order to ensure these patients are offered appropriate advice and support
• Improve system for communication with the staff team.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice